Integrating clinical data from cross-sectional and longitudinal studies

Clinical trials are typically conducted over a population in order to illuminate certain characteristics of a health issue or disease process. These cross-sectional studies provide a snapshot of these disease processes over a large population but do not allow us to model the temporal nature of disease. Longitudinal studies on the other hand, are used to explore how these processes develop over time but can be expensive and time-consuming, and only cover a relatively small window within the disease process. This paper explores a technique for integrating cross-sectional and longitudinal studies to build models of disease progression

Decreasing initial telomere length in humans intergenerationally understates age-associated telomere shortening

Telomere length shortens with aging, and short telomeres have been linked to a wide variety of pathologies. Previous studies suggested a discrepancy in age-associated telomere shortening rate estimated by cross-sectional studies versus the rate measured in longitudinal studies, indicating a potential bias in cross-sectional estimates. Intergenerational changes in initial telomere length, such as that predicted by the previously described effect of a father's age at birth of his offspring (FAB), could explain the discrepancy in shortening rate measurements. We evaluated whether changes occur in initial telomere length over multiple generations in three large datasets and identified paternal birth year (PBY) as a variable that reconciles the difference between longitudinal and cross-sectional measurements. We also clarify the association between FAB and offspring telomere length, demonstrating that this effect is substantially larger than reported in the past. These results indicate the presence of a downward secular trend in telomere length at birth over generational time with potential public health implications

mHealth Series:mHealth project in Zhao County, rural China - Description of objectives, field site and methods

BACKGROUND: We set up a collaboration between researchers in China and the UK that aimed to explore the use of mHealth in China. This is the first paper in a series of papers on a large mHealth project part of this collaboration. This paper included the aims and objectives of the mHealth project, our field site, and the detailed methods of two studies. FIELD SITE: The field site for this mHealth project was Zhao County, which lies 280 km south of Beijing in Hebei Province, China. METHODS: We described the methodology of two studies: (i) a mixed methods study exploring factors influencing sample size calculations for mHealth–based health surveys and (ii) a cross–over study determining validity of an mHealth text messaging data collection tool. The first study used mixed methods, both quantitative and qualitative, including: (i) two surveys with caregivers of young children, (ii) interviews with caregivers, village doctors and participants of the cross–over study, and (iii) researchers’ views. We combined data from caregivers, village doctors and researchers to provide an in–depth understanding of factors influencing sample size calculations for mHealth–based health surveys. The second study, a cross–over study, used a randomised cross–over study design to compare the traditional face–to–face survey method to the new text messaging survey method. We assessed data equivalence (intrarater agreement), the amount of information in responses, reasons for giving different responses, the response rate, characteristics of non–responders, and the error rate. CONCLUSIONS: This paper described the objectives, field site and methods of a large mHealth project part of a collaboration between researchers in China and the UK. The mixed methods study evaluating factors that influence sample size calculations could help future studies with estimating reliable sample sizes. The cross–over study comparing face–to–face and text message survey data collection could help future studies with developing their mHealth tools

Analysing motivation to do medicine cross-culturally : the international motivation to do medicine scale

Vaglum, Wiers-Jensen & Ekeberg (1999) developed an instrument to assess motivation to study medicine. This instrument has been applied in different countries but it has not been studied cross-culturally. Our aims were to develop a Motivation to do Medicine Scale for use in international studies and to compare motivations of UK and Spanish medical students (UK: n= 375; Spain: n= 149). A cross-sectional and cross-cultural study was conducted. The Vaglum et al. (1999) Motivation to do Medicine Scale (MMS) was used. The original MMS factor structure was not supported by the Confirmatory Factor Analysis. Exploratory Factor Analyses within each country identified four factors: 'People', 'Status', 'Natural Science' and 'Research'. Students scored higher on the 'People' and 'Natural Science' than on the other factors. The UK sample scored higher than the Spanish sample on the 'Research' factor and there were greater difference between genders in Spain for both 'People' and 'Research' factors. The scale is suitable for use in cross-cultural studies of medical students' motivation. It can be used to investigate differences between countries and may be used to examine changes in motivation over time or over medical disciplines

Secondary cytotoxicity of (crosslinked) dermal sheep collagen during repeated exposure to human fibroblasts

We investigated commercially available dermal sheep collagen either cross-linked with hexamethylenediisocyanate, or cross-linked with glutaraldehyde. In previous in vitro studies we could discriminate primary, i.e. extractable, and secondary cytotoxicity, due to cell-biomaterial interactions, i.e. enzymatic actions. To develop dermal sheep collagen for clinical applications, we focused in this study on the release, e.g. elimination, of secondary cytotoxicity over time. We used the universal 7 d methylcellulose cell culture with human skin fibroblasts as a test system. Hexamethylenediisocyanate-cross-linked dermal sheep collagen and glutaraldehyde-cross-linked dermal sheep collagen were tested, with intervals of 6 d, over a culture period of 42 d. With hexamethylenediisocyanate-cross-linked dermal sheep collagen, cytotoxicity, i.e. cell growth inhibition and deviant cell morphology, was eliminated after 18 d of exposure. When testing glutaraldehyde-cross-linked dermal sheep collagen, the bulk of cytotoxic products was released after 6 d, but a continuous low secondary cytotoxicity was measured up to 42 d. As a control, non-cross-linked dermal-sheep collagen was tested over a period of 36 d, but no secondary cytotoxic effects were observed. The differences in release of secondary cytotoxicity between hexamethylenediisocyanate-cross-linked dermal sheep collagen, glutaraldehyde-cross-linked dermal sheep collagen and non-cross-linked dermal sheep collagen are explained from differences in cross-linking agents and cross-links obtained. We hypothesize that secondary cytotoxicity results from enzymatic release of pendant molecules from hexamethylene-diisocyanate-cross-linked dermal sheep collagen, e.g. formed after reaction of hydrolysis products of hexamethylenediisocyanate with dermal sheep collagen. Glutaraldehyde-cross-linked dermal sheep collagen contains residual cross-linking agents, which induce the bulk cytotoxicity. Apart from being sensitive to enzymatic degradation, glutaraldehyde-cross-linked dermal sheep collagen was also found to be sensitive to aqueous hydrolysis. Hydrolysis of cross-links may release cytotoxic products and introduce new pendant molecules within glutaraldehyde-cross-linked dermal sheep collagen, which in turn induce cytotoxicity after enzymatic attack

Consumer Risk Reactions to Food Product-Harm Crises Over Time: Evidence From Cross-Cultural Field Studies

Consumer/Household Economics, Risk and Uncertainty,

Health Expenditure and Income in the United States

This paper investigates the long-run economic relationship between health care expenditure and income in the US at a State level. Using a panel of 49 US States followed over the period 1980-2004, we study the non-stationarity and cointegration between health spending and income, ultimately measuring income elasticity of health care. The tests we adopt allow us to explicitly control for cross-section dependence and unobserved heterogeneity. Specifically, in our regression equations we assume that the error is the sum of a multifactor structure and a spatial autoregressive process, which capture global shocks and local spill overs in health expenditure. Our results suggest that health care is a necessity rather than a luxury, with an elasticity much smaller than that estimated in other US studies. Further, we observe a significant spatial spill over, though with a smaller intensity than that detected in other studies on spatial concentration of US health spending. Our broad perspective of cross section dependence as well as the methods used to capture it give new insights on the debate over the relationship between health spending and income.Health expenditure; income elasticity; cross section dependence; panels

Ferromagnetic to spin glass cross over in (La,Tb)_{2/3}Ca_{1/3}MnO_{3}

In the series La_{2/3-x}Tb_{x}Ca_{1/3}MnO_{3}, it is known that the compositions are ferromagnetic for smaller values of x and show spin glass characteristics at larger values of x. Our studies on the magnetic properties of various compositions in the La_{2/3-x}Tb_{x}Ca_{1/3}MnO_{3} series show that the cross over from ferromagnetic to spin glass region takes place above x ~ 1/8. Also, a low temperature anomaly at 30 K, observed in the ac susceptibility curves, disappears for compositions above this critical value of x. A mixed phase region coexists in the narrow compositional range 0.1 <= x <= 0.125, indicating that the ferromagnetic to spin glass cross over is not abrupt.Comment: 5 pages, 5 figure